Oesophageal perforations: an experience with 120 cases [1974-1987]

In this article the experience with the different types of esophageal perforation encountered at the Cardiothoracic Surgery Unit of Alexandria University during the period from June 1974 through August 1987, is presented. Throughout this period 120 cases of esophageal perforation due to various causes were studied with regard to their incidence, etiology, diagnosis and management. The commonest cause of esophageal perforation in the present series was esophageal instrumentation intended for dilatation of caustic esophageal strictures

Diagnostic approaches to the mediastinum

The evaluation and treatment of mediastinal lesions requires a thorough acquaintance with the diagnostic approach or combination of approaches to the mediastinum. In the present series this entailed the study of 136 patients submitted to different diagnostic approaches. CT scanning and anterior mediastinotomy yielded the best diagnostic results. CT-guided needle biopsy and transtracheal mediastinal lymphography were less conclusive, but definitely helpful tools. Mediastinoscopy is still considered helpful in the evaluation of lesions in the posterior part of the superior mediastinum. Scalene lymph node biopsy remains to have its attraction in view of its simplicity and practically absence of morbidity. The merits and demerits of each of these diagnostic tools are discussed in this article

Effect of splenectomy on platelet antibodies and serum immunoglobulins in schistosomiasis

The preset trial was carried out to detect the presence of platelet antibodies and to assess serum immunoglobulins in schistosomiasis before and after splenectomy. The study included 50 male cases with schistosomal hepatosplenomegaly and 10 normal male subjects as controls. Splenectomy was performed in 10 cases showing evidences of hypersplenism. Moderate thrombocytopenia was observed in all schistosomal cases. Platelet antibodies were detected in 30% of schistosomal cases associated with marked thrombocytopenia. Serum immunoglobulin G and M were significantly increased in bilharzial patients as compared to controls, which was more pronounced in respect to IgG in cases having platelet antibodies. Following splenectomy, significant increase of platelet count and significant reduction of platelet antibodies were found without any associated changes in serum immunoglobulins. Results were fully discussed

use of a pedicled pericardial flap to reinforce oesophageal anastomosis: a preliminary report

The article presents a new technique for reinforcement and protection of lower intrathoracic esophageal anastomosis after resection of lower esophageal and high gastric tumors. It entails the use of a rectangular pedicled flap derived from the neighboring pericardium. It was carried out on seven patients; four with lower esophageal and three with gastric cardiac tumors. Patients were all males. They ranged in age from 49 to 63 years, with a mean age of 55.3 years. None of the patients developed anastomotic leakage after operation. The technique proved to be simple, safe and attended with a short hospital stay

Pharyngolaryngectomy and blind oesophagectomy followed by pharyngogastrostomy in the management of hypopharyngeal carcinoma

In this study, 14 patients with hypopharyngeal carcinoma were submitted to pharyngolaryngectomy with blind esophagectomy without thoracotomy followed by gastric pull-up and pharyngogastrostomy. Nine patients were males and five were females. They ranged in age from 20 to 65 years with a mean age of 42.9 years. The procedure proved to be simple, safe and not time consuming. The operative technique, morbidity and mortality were discussed with reference to similar and other procedures reported in the literature

Determination of the mitral valve area in isolated rheumatic mitral stenosis: a prospective study

In 15 patients undergoing closed mitral valvotomy for isolated mitral stenosis, the motral valve area was directly measured during operation prior to valvotomy. All patients had tight mitral stenosis ranging from 0.4 cm to 1.4 cm. The data obtained during operation were correlated with the echocardiographic and cardiac catheterization estimates of the mitral valve area before operation. It was found that, although the EF slope estimated by M-mode echo was reliable in diagnosing mitral stenosis, yet, it was inaccurate in predicting variations in the size of the stenotic valve. Left cardiac catheterization, on the other hand yielded more accurate and reliable values in predicting the severity of mitral stnosis

Cardiac output determination in thirty patients undergoing closed mitral commissurotomy

Cardiac output was estimated using the thermodilution technique in 30 patients undergoing closed mitral commissurotomy for isolated rheumatic mitral stenosis. The effects of surgery, anaesthesia and thoracotomy on cardiac output are studied and discussed with reference to their underlying aetiological mechanism and their practical surgical and anaesthetic implications

Carcinoembryonic antigen and cancer serum index in carcinoma of the oesophagus

Carcinoembryonic antigen [CEA], cancer serum index [CSI] and total plasma proteins with its various electrophoretic fractions were assessed in 15 patients with esophageal cancer, 10 patients with benign esophageal cancer, 10 patients with benign esophageal lesions and 10 healthy controls. Nonsignificant changes of all parameters studied were detected in patients with benign lesions as compared to the control group. However, in patients with esophageal carcinoma, serum albumin were significantly decreased, while serum alpha 1 acid globulin, alpha 1 acid glycoprotein, CEA and calculated CSI were significantly increased as compared to the control group and to patients with benign lesions. Results are fully discussed

Chest wall tumour: experience with 83 patients

In this article, a clinicopathological review of 83 patients with chest wall tumors, which represents the experience with these tumors over the past 12 years, is presented. Sixty patients were males and 23 were females. Their age ranged from 40 to 76 years with a mean age of 42.3 years. Twenty-three patients had benign tumors, while 60 had malignant tumors. Most patients with malignant tumors presented in an advanced stage with a mean delay time between the onset of symptoms and definitive histopathological diagnosis of 9.2 months. The latter was achieved in all cases by incisional biopsy. The policy of treatment was rather conservative since most patients with malignant tumors presented in an advanced stage and had a limited life expectancy

Reflections on some structural and functional changes after closed mitral commissurotomy for rheumatic mitral stenosis

The aim of this study was to assess some structural and functional changes after closed mitral commissurotomy in 50 patients with rheumatic mitral stenosis. It was found that after dilatation of the mitral valve the mobility of the valve improved, the mitral valve area increased but there was an insignificant decrease in the size of the left atrium as well as an insignificant increase in the size of the left ventricle. On the other hand, there was an associated improvement in the backward failure in terms of reduction in the pulmonary congestion and pulmonary precapillary pressure as well as a correction of the foreward failure in terms of an increase in the cardiac output

role of mediastinotomy in the diagnosis of intrathoracic disease [a clinicopathologic study]

Twenty patients with mediastinal, pulmonary and pleural disease were submitted to anterior mediastinotomy as an investigative tool. Diagnostic anterior mediastinotomy yielded positive results in 100 percent of cases and is believed to be far superior to the other diagnostic procedures such as radiography, bronchoscopy and scalene lymph node biopsy. Although the procedure was attended with some complications, yet they were easily managed and no mortality was incurred in the series presented. The indications, operative technique, complications and pathologic findings are discussed

Corrosive injury of the stomach in potash poisoning: a histopathologic study

Twenty patients with complete oesophageal obstruction consequent upon the ingestion of caustic potash were studied. Biopsies were obtained from the fundus of the stomach as well as from the pyloric antrum, during the procedure of a feeding gastrostomy, with the aim to study the incidence and nature of gastric affection in potash poisoning. Histopathologic changes were demonstrated in 65% of the pyloric biopsies and in 16.6% of biopsies obtained from the fundus of the stomach. The results are discussed and the possible clinical implications of these histopathologic alterations are mentioned